From the teenage girl who would chew on screws as a form of self-harm to a boy who would hurl insults for hours before calming down, many of the youth in care staying at Aunt Martha’s Health and Wellness’ Integrated Care Center (ICC) are living with deep traumas and complex mental health care needs.
“We get some of the most acute kids in the state of Illinois,” said Dr. Wanda Parker, chief clinical officer at Aunt Martha’s Health and Wellness, which provides integrated care, support, and specialized care to 130,000 kids and adults across the state. “When I say acute, I mean their conditions are severe. They require closer monitoring, more interventions, and more specialized types of treatment.”
At the ICC, some youth are highly aggressive and suicidal. Some have very low self-esteem and low self-acceptance. Being under the custody of the Illinois Department of Children and Family Services (DCFS), some of the youth have experienced neglect, abandonment, and abuse from parents and caregivers. Others have been in and out of multiple placements.
They require medical treatment and mental health support until DCFS finds and secures their next placement.
Student interns from Adler Community Health Services (ACHS) join an interdisciplinary team of providers — including the chief medical officer, chief clinical officer, care coordinators, nurses, education specialists, and therapists — to provide evidence-based, value-driven, and trauma-informed care at the ICC.
“Each of us plays a key role in making sure that these youths feel safe and cared for,” said Adam Hiebel, a Doctor of Psychology in Clinical Psychology (Psy.D.) student who has spent nearly two years interning and externing at the ICC.
Hiebel — along with Andrew Sarkisian, a Chicago School of Professional Psychology clinical psychology student who is conducting his internship through ACHS — primarily works with the ICC’s in-house therapist to identify certain goals for the youths on their caseloads.
The treatment team’s efforts have resulted in positive outcomes, including a 47% decrease in hospitalization within two weeks of ICC placement, 68% decrease in acts of aggression within four weeks of placement, and 71% reduction in medication-related incidents within eight weeks of placement.
“Their trauma is just so complex that it takes time to walk them through that trauma narrative,” said Hiebel. “But to see that growth in the youth is so powerful.”
From shelter to integrated care center
Formally set up as a traditional residential shelter and intake hub for DCFS youth in Cook County, the ICC was a place for kids to go while DCFS figured out where to place them next.
But some youth had such complicated mental health care needs that finding them new placements proved difficult, according to Dr. Parker.
Up to 80% of children in foster care have significant mental health issues, compared to approximately 18-22% of the general population, according to a brief by the National Conference of State Legislatures on mental health and foster care.
“Factors contributing to the mental and behavioral health of children and youth in foster care includes the history of complex trauma, frequently changing situations and transitions, broken family relationships, inconsistent and inadequate access to mental health services and over-prescription of psychotropic medications,” according to the NCLS, which represents the legislatures in the states, territories, and commonwealths of the U.S.
As of April 2023, there are 20,448 children in foster care in Illinois, according to DCFS.
For some of them, they find themselves placed in the 33-bed facility of the ICC, which in the past five years has evolved into a physician-led, trauma-informed treatment setting specializing in caring for DCFS youths with the most significant mental health needs.
“Families couldn’t manage them. Programs which have had them in the past declined to take them back in,” said Dr. Parker. “But what we’ve seen in every case that DCFS has given us, our integrated team has helped these kids get better.”
The girl who would chew on screws — resulting in getting hospitalized multiple times a month — became hospital-free. The ICC was able to advocate for her to be accepted to a new placement. The boy who would get combative with staff — one of Sarkisian’s clients — learned how to self-regulate and ask for help.
“It’s all because of the hard work of our staff and the interns,” said Dr. Parker. “The ACHS interns really do add a layer of clinical expertise and interventions for the kids.”
The ACHS and Aunt Martha’s partnership began in 2018, as Adler students interned in several primary care clinics in the suburbs. But due to transportation issues, ACHS interns began working at locations within the city.
This includes the Humboldt Park Community Health Center, located in the Ukrainian Village neighborhood of Chicago, where Sarkisian serves as a behavioral health consultant and therapist at one of the integrated care clinics.
“I’m working with different providers, assessing mental health needs, coordinating community resources, and providing short-term interventions for new patients,” he said.
On Thursdays, Sarkisian is at the ICC, located on the South Side of Chicago. Hiebel is at the ICC full time, spending three days a week at the location.
The duo joins the full integrated team, which meets weekly to discuss the current needs of the youths staying there. The interns are then given specific cases or assignments to work on and report back to the team. For Sarkisian and Hiebel, the experience gained at the ICC has been invaluable.
ACHS — a community-embedded service model whereby services would occur in the communities most in need of mental health care — has two approaches with its community partners: one where the ACHS team’s expertise, including interns, is used in leadership and design of services; the other is where they are integrated into a clinical care team.
“At the ICC, it’s very much the latter,” said ACHS Clinical Faculty Maryah Qureshi. “And the staff at Aunt Martha’s has accepted our trainees as part of their team, which is huge when it comes to developing our students.”
“The partnership with Aunt Martha’s works well because they value the opportunity to teach our students, who then add value to their work,” added Michelle Anderson, Ph.D., director of training, ACHS Division of Community Health Chicago. “There are limited resources to do a lot of work, but they’re a partner that’s willing to work with issues when they come up, value the training aspect, and give you constructive feedback. As a training program, that’s often all you need.”
A former middle school teacher, Hiebel said he loves working with the youth, especially those in marginalized groups.
“You really need to have that passion for working with kids because you never know what you’re going into when they come into the session,” he said.
Hiebel is often assigned transgender youths, some of whom are undergoing the transition process.
“I usually get those cases because that’s my area of interest in the field,” he said. “So, I help them talk through the process, discuss acceptance, coming out, and coming to terms with their gender and sexual identities.”
Sarkisian, who has also worked with kids in the past, admits he wasn’t familiar with the organization before the internship assignment.
“But I get to work with adolescents again, and I’ve grown to feel like it’s a good match,” he said. “I admire the trauma-informed approach, which is broadly emphasized at Aunt Martha’s. This is essential when helping our youths, given their life experiences.”
When it comes to measuring successes, both interns agree on the same thing: it’s the little gains that add up to big wins.
“A lot of them have very low self-esteem,” Hiebel said. “It’s hard to measure, but you see that growth and progress of the youth getting a little more confident in themselves, a little more self-empowered.”
With one transgender youth, Hiebel focused on helping them gain more confidence when introducing themselves to new acquaintances.
“Now I see the confidence in this particular youth,” he said. “They go to school and introduce themselves with their preferred pronoun.”
Progress is also often not linear, Sarkisian said.
“It can come and go,” he said. “I think a lot of times, the progress is very subtle or slow-going. Maybe for the first time, they’re feeling safe in new friendships and relationships; they’re feeling more autonomy and personal agency; they’re able to regulate distressing emotions and have greater emotional resilience.”
But each small triumph leads to the ultimate goals: improving each ICC foster care youth’s health, safety, independence, and chances to finding a new home.